scholarly journals Liberal transfusion strategy improves survival in perioperative but not in critically ill patients

2016 ◽  
Vol 117 (3) ◽  
pp. 401
Author(s):  
G.M. Liumbruno ◽  
G. Biancofiore ◽  
G. Marano ◽  
C. Mengoli ◽  
M. Franchini
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Transfusion Strategy ◽  
Liberal Transfusion

Restrictive versus Liberal Transfusion Strategy in the Perioperative and Acute Care Settings

2016 ◽  
Vol 125 (1) ◽  
pp. 46-61 ◽  
Author(s):  
Frédérique Hovaguimian ◽  
Paul S. Myles
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Oxygen Supply ◽  
Grey Literature ◽  
Patient Characteristics ◽  
Major Surgery ◽  
Specific Approach ◽  
Context Specific ◽  
Liberal Transfusion ◽  
Transfusion Protocol

Abstract Background Blood transfusions are associated with morbidity and mortality. However, restrictive thresholds could harm patients less able to tolerate anemia. Using a context-specific approach (according to patient characteristics and clinical settings), the authors conducted a systematic review to quantify the effects of transfusion strategies. Methods The authors searched MEDLINE, EMBASE, CENTRAL, and grey literature sources to November 2015 for randomized controlled trials comparing restrictive versus liberal transfusion strategies applied more than 24 h in adult surgical or critically ill patients. Data were independently extracted. Risk ratios were calculated for 30-day complications, defined as inadequate oxygen supply (myocardial, cerebral, renal, mesenteric, and peripheral ischemic injury; arrhythmia; and unstable angina), mortality, composite of both, and infections. Statistical combination followed a context-specific approach. Additional analyses explored transfusion protocol heterogeneity and cointerventions effects. Results Thirty-one trials were regrouped into five context-specific risk strata. In patients undergoing cardiac/vascular procedures, restrictive strategies seemed to increase the risk of events reflecting inadequate oxygen supply (risk ratio [RR], 1.09; 95% CI, 0.97 to 1.22), mortality (RR, 1.39; 95% CI, 0.95 to 2.04), and composite events (RR, 1.12; 95% CI, 1.01 to 1.24—3322, 3245, and 3322 patients, respectively). Similar results were found in elderly orthopedic patients (inadequate oxygen supply: RR, 1.41; 95% CI, 1.03 to 1.92; mortality: RR, 1.09; 95% CI, 0.80 to 1.49; composite outcome: RR, 1.24; 95% CI, 1.00 to 1.54—3465, 3546, and 3749 patients, respectively), but not in critically ill patients. No difference was found for infections, although a protective effect may exist. Risk estimates varied with successful/unsuccessful transfusion protocol implementation. Conclusions Restrictive transfusion strategies should be applied with caution in high-risk patients undergoing major surgery.

scholarly journals Mortality in Critically Ill Patients Does Not Differ according to Transfusion Strategy

2021 ◽  
pp. 1-3
Author(s):  
Filippo Sanfilippo ◽  
Luigi La Via ◽  
Paolo Murabito ◽  
Marinella Astuto
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Transfusion Strategy

scholarly journals Red blood cell transfusions worsen the outcomes even in critically ill patients undergoing a restrictive transfusion strategy

2012 ◽  
Vol 130 (2) ◽  
pp. 77-83 ◽  
Author(s):  
João Manoel da Silva Junior ◽  
Ederlon Rezende ◽  
Cristina Prada Amendola ◽  
Rafael Tomita ◽  
Daniele Torres ◽  
...  
Keyword(s):  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Apache Ii Score ◽  
Transfusion Strategy ◽  
Acute Hemorrhage ◽  
Restrictive Transfusion ◽  
Coronary Syndrome ◽  
Icu Stay ◽  
Restrictive Transfusion Strategy

CONTEXT AND OBJECTIVE: Anemia and blood transfusions are common in intensive care. This study aimed to evaluate epidemiology and outcomes among critically ill patients under a restrictive transfusion strategy. DESIGN AND SETTING: Prospective observational cohort study in an intensive care unit (ICU) at a tertiary hospital. METHODS: All adults admitted to the ICU over a one-year period who remained there for more than 72 hours were included, except those with acute coronary syndrome, ischemic stroke, acute hemorrhage, prior transfusion, pregnant women and Jehovah's Witnesses. The restrictive strategy consisted of transfusion indicated when hemoglobin levels were less than or equal to 7.0 g/dl. RESULTS: The study enrolled 167 patients; the acute physiology and chronic health evaluation II (APACHE II) score was 28.9 ± 6.5. The baseline hemoglobin level was 10.6 ± 2.2 g/dl and on day 28, it was 8.2 ± 1.3 g/dl (P < 0.001). Transfusions were administered to 35% of the patients. In the transfusion group, 61.1% did not survive, versus 48.6% in the non-transfusion group (P = 0.03). Transfusion was an independent risk factor for mortality (P = 0.011; odds ratio, OR = 2.67; 95% confidence interval, CI = 1.25 to 5.69). ICU stay and hospital stay were longer in the transfusion group: 20.0 (3.0-83.0) versus 8.0 (3.0-63.0) days (P < 0,001); and 24.0 (3.0-140.0) versus 14.0 (3.0-80.0) days (P = 0.002), respectively. CONCLUSIONS: In critically ill patients, there was a reduction in hemoglobin with increasing length of ICU stay. Moreover, transfusion was associated with worse prognoses.

Restrictive Versus Liberal Transfusion Strategies for Older Mechanically Ventilated Critically Ill Patients

2013 ◽  
Vol 41 (10) ◽  
pp. 2354-2363 ◽  
Author(s):  
Timothy S. Walsh ◽  
Julia A. Boyd ◽  
Douglas Watson ◽  
David Hope ◽  
Steff Lewis ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Mechanically Ventilated ◽  
Liberal Transfusion
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